Once menopause is on the horizon, declining estrogen levels and changes in vaginal bacteria can make you more, well, sensitive down there. "But painful sex isn't something to endure," says actress Virginia Madsen, a spokesperson for FindingTheWords.com, a site to promote discussing the issue. "Arm yourself with information and talk to your doctor." These three questions are a good way to begin the conversation.

"Could pH be the problem?"

For perimenopausal women in particular, anything from hormonal changes to using vaginal wipes can throw off the vagina's balance of good and bad bacteria, says Alyssa Dweck, M.D., an ob-gyn at Mount Kisco Medical Group in New York and a certified sex therapist. Getting back to a normal pH might involve taking an oral probiotic (like Pro-B) or applying RepHresh gel.

"Is estrogen worth trying?"

Let lubes and moisturizers be your first line of defense. Next, your doctor might recommend local estrogen therapy, which is administered as a vaginal tablet, ring or topical cream or gel. "But it's not a good choice for a woman who's had breast cancer, uterine cancer or undiagnosed abnormal vaginal bleeding," says Dr. Dweck.

"Are there any new treatments?"

Osphena is the first oral, non-estrogen option for this issue and was approved by the FDA last year. "It's a great product to have as a choice," says Dr. Dweck, who is also co-author of V Is for Vagina. "Some patients, however, are turned off by common side effects — like hot flashes and muscle cramps."

Originally published in the March 2014 issue of Family Circle magazine.